| Entity Name: | INNOVATIVE BEHAVIORAL HEALTH SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 06 Sep 2017 (7 years ago) |
| Date of dissolution: | 30 Jan 2019 (6 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Jan 2019 (6 years ago) |
| Document Number: | L17000189569 |
| FEI/EIN Number | 82-2720861 |
| Mail Address: | 1938 SE 22ND CT, HOMESTEAD, FL 33035 |
| Address: | 26750 S DIXIE HIGHWAY, HOMESTEAD, FL 33032 |
| ZIP code: | 33032 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881103224 | 2017-09-28 | 2018-06-16 | 1938 SE 22ND CT, HOMESTEAD, FL, 330351238, US | 26750 S DIXIE HWY, HOMESTEAD, FL, 330327431, US | |||||||||||||||||||||||||||
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| Phone | +1 786-712-2314 |
Authorized person
| Name | LUCKNER C DENORD |
| Role | PRESIDENT AND CEO |
| Phone | 7867122314 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 106E00000X - Assistant Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 684990 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DENORD, LUCKNER C | Agent | 1938 SE 22ND CT, HOMESTEAD, FL 33035 |
| Name | Role | Address |
|---|---|---|
| DENORD, LUCKNER C | Chief Executive Officer | 1938 SE 22ND CT, HOMESTEAD, FL 33035 |
| Name | Role | Address |
|---|---|---|
| SAINT-CYR, NADEGE | Lead Behavioral Health Analyst | 1930 NW 115TH STREET, MIAMI, FL 33167 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-01-30 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-07 | 26750 S DIXIE HIGHWAY, HOMESTEAD, FL 33032 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2019-01-30 |
| ANNUAL REPORT | 2018-04-11 |
| Florida Limited Liability | 2017-09-06 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
